• Complications in 51 Consecutive Patients Undergoing Cranioplasty following Decompressive Craniectomy for Traumatic Brain Injury

    Final Number:

    Angelos G. Kolias MSc, MRCS; Vin S. Ban; Lucia M. Li; Thomas Santarius MD; Peter J. Kirkpatrick FRCS; Peter J. Hutchinson PhD, FRCS (SN)

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Cranioplasty to repair the skull defect following craniectomy aims to restore skull integrity and improve cosmesis. It has also been suggested that it may facilitate rehabilitation after TBI.

    Methods: This retrospective single-centre study reviewed a series of consecutive TBI patients who underwent a cranioplasty from January 2008 to December 2010, with the aim of identifying complications. Data on operations, complications and patient characteristics were extracted from operating theatre registers and patient records.

    Results: 51 cranioplasties were identified. All plates inserted were titanium. The DC was unilateral in 39 and bifrontal in 12 cases. The median time between DC and cranioplasty was 9 months (Q1 – Q3: 6 – 12 months). The median follow-up time was 27 months (range 8 – 39 months). Mortality (30-day) was zero. Eleven cases returned to theatre: 5 (9.8%) for removal of infected plate, 5 (9.8%) for revision (1 after fall, 1 for loose portion, 1 for discomfort, 2 for cosmesis) and 1 (2%) for evacuation of an extradural haematoma secondary to therapeutic anticoagulation. The mean time between cranioplasty and removal of an infected plate was 15 weeks (range 4 – 56 weeks). MSSA was cultured from 4 and MRSA from 1 of the infected cases. Four of the 5 patients who developed an infection had a pertinent co-morbidity (smoking, diabetes, immune-suppression, previous cranioplasty removal) compared to 15 out of 46 without an infection (p=0.058). In 2 out of 6 patients who were established on anti-convulsants for seizures pre-cranioplasty, seizures recurred immediately post-operatively; 1 of them required ITU admission. No patients experienced new-onset seizures after cranioplasty.

    Conclusions: The most commonly occurring complications were infection, revision and seizures. The complication rate in this series is comparable to that reported in the literature. Prospective multi-centre studies have the potential to answer important clinical questions (such as optimal timing) regarding cranioplasty.

    Patient Care: We are proposing prospective multi-centre studies in order to answer important clinical questions (such as optimal timing) regarding cranioplasty.

    Learning Objectives: By the conclusion of this session, participants should be able to describe the complications of cranioplasty.

    References: 1. Gooch MR et al. Neurosurg Focus 2009 2. Stiver SI. Neurosurg Focus 2009 Acknowledgements: AGK is supported by a Royal College of Surgeons of England Research Fellowship, an NIHR Academic Clinical Fellowship and a Raymond and Beverly Sackler Studentship. PJH is supported by an Academy of Medical Sciences/Health Foundation Senior Surgical Scientist Fellowship.

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